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Ten-year survival and prognostic markers in one thousand patients with advanced heart failure. A single-centre
Peter Lesny1, Milan Luknar1, Martin Matejka2
1Heart Failure and Transplant Department, National Cardiovascular Institute, Bratislava, Slovak Republic.
Insights
Simple clinical markers can predict one-year mortality in advanced heart failure (HF) patients. Identifying these prognostic indicators aids in selecting suitable candidates for heart replacement therapy, improving patient outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Research
Background:
- Advanced heart failure (HF) patients are candidates for heart transplantation and mechanical circulatory support.
- Accurate prognostic markers are crucial for selecting appropriate patients for heart replacement therapy.
Purpose of the Study:
- To identify simple, reliable markers for predicting one-year mortality in advanced HF patients.
- To aid in the selection process for heart replacement therapy.
Main Methods:
- Analysis of 1000 consecutive advanced HF patients over a 12-year period.
- Kaplan-Meier survival analysis and logistic regression to identify mortality predictors.
- Assessment of clinical parameters, including medical history, laboratory values, and medication dosage.
Main Results:
- One-year survival rate was 83%, with significant declines at 3, 5, 7, and 10 years.
- Independent predictors of one-year mortality included coronary artery disease, left ventricular diastolic diameter >79 mm, low plasma sodium (<135 mmol/L), need for IV treatment on admission, and high furosemide dose at discharge (>240 mg/day).
Conclusions:
- Short-term prognosis in HF patients can be reliably estimated using simple clinical parameters.
- Patients exhibiting poor prognostic signs warrant referral to tertiary centers for consideration of advanced therapies.
Aim:
Patients with advanced heart failure (HF) represent a pool of candidates for heart transplantation and long-term mechanical circulatory support devices. The aim of our study was to determine simple and reliable markers of one-year mortality for selection of the most suitable patients for heart replacement therapy.
Methods And Results:
One thousand consecutive patients with HF (mean age 49 ± 10.9 years; 86.8% males) referred to a single tertiary centre from January 1998 to January 2010 in order to assess the indication for heart transplantation were enrolled. Kaplan-Meier survival analysis was performed. Independent mortality predictors were established using logistic regression analysis. The mean follow-up was 4.3 ± 2.7 years (range 1-12 years). Cumulative survival was as follows: 1-year survival 83%, 3-year 63%, 5-year 50%, 7-year 39%, and 10-year 23%. Independent predictors of 1-year mortality included coronary artery disease, left ventricular diastolic diameter >79 mm, plasma sodium <135 mmol/L, the need for intravenous treatment at hospital admission (diuretics and/or inotropes), and furosemide dose at discharge >240 mg/day.
Conclusions:
Short-term prognosis of HF patient can be estimated based on simple parameters. Patients with signs of poor prognosis should be referred to tertiary centres to be considered for heart replacement therapy.
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